Provider Demographics
NPI:1740722826
Name:CITYCARE HOMEHEALTH PROVIDER INC
Entity type:Organization
Organization Name:CITYCARE HOMEHEALTH PROVIDER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KUNLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ONIFADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-202-6920
Mailing Address - Street 1:11633 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2321
Mailing Address - Country:US
Mailing Address - Phone:323-202-6920
Mailing Address - Fax:310-695-1521
Practice Address - Street 1:11633 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2321
Practice Address - Country:US
Practice Address - Phone:323-202-6920
Practice Address - Fax:310-695-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health